Peritoneal Dialysis (PD) treatment, a life-saving therapy for individuals with end-stage renal disease, is witnessing a remarkable transformation with the emergence of Artificial Intelligence (AI) technologies. AI is revolutionizing the field of PD by providing innovative solutions to enhance patient outcomes, optimize treatment protocols, and streamline clinical decision-making. Through the integration of machine learning algorithms, predictive analytics, and real-time monitoring systems, AI is enabling healthcare professionals to personalize PD therapy, detect complications early, and improve overall patient management. This synergy between AI and PD holds tremendous potential to reshape the landscape of renal care, offering a more efficient, precise, and patient-centric approach to this critical treatment modality.
Over the next couple of weeks, I will explore the latest in the application of AI methodologies to Peritoneal Dialysis regimens. My goal is to provide a short introduction to a specific AI concept, such as Machine Learning Models and their role in predicting dialysis outcomes, followed by pertinent real-time examples of the employment of these concepts in evolving situations.
My first effort in this area is captured in the video below. I was assisted by the AI assistant ChatGPT4, and Grammarly for improved dialog, and by app.VideoCreator.io for converting the script thus authored into the rendered video.
May 15, 2023, The Wall Street Journal included a special section named “Innovations In Work.” This section includes an article on page R1 by Sean Captain titled “How AI Will Change The Workplace.” He postulates that it will provide an edge for the aged. IBID page R4 by Joseph F. Coughlin, Director of AgeLab, Massachusetts Institute of Technology, suggests that older workers exhibit greater crystallized intelligence. I pondered this concept and postulated that it could, should, would apply equally to dialysis patients as, by and large, they are of older age, all else being equal.
I wrote the following Prompt to test my hypothesis and submitted it to my ChatbotGPT4 with the following result. As is my habit, I used Grammarly to clean up the prose and Bing Image Creator for the lead graphic.
Prompt: It has been suggested that artificial intelligence will provide an edge for the aged because older workers are thought to exhibit greater crystallized intelligence — the capacity to leverage experience and knowledge over the years to quickly see patterns, nuance, and emotional insights and the capacity to determine which problems should be addressed and which are just noise. Write a lengthy blog post on how these concepts of artificial intelligence apply to those on dialysis.
Result:
The idea of integrating artificial intelligence (AI) into healthcare has been steadily gaining traction over the past few years. Now more than ever, the potential for AI to play a significant role in patient care, particularly for those on dialysis, is undeniable. For older patients, AI offers an opportunity to enhance their treatment and allows them to leverage their crystallized intelligence — the ability to use knowledge, wisdom, and experience gained over the years — to manage their health more effectively.
Understanding Crystallized Intelligence
Crystallized intelligence is the culmination of a lifetime’s worth of experiences, knowledge, and problem-solving skills. It’s the ability to see patterns and nuances, understand emotional insights, and determine which problems must be addressed and which can be set aside as noise. In the context of dialysis patients, crystallized intelligence can be particularly beneficial.
Older patients undergoing dialysis have often managed their kidney disease over many years. They’ve developed a deep understanding of their bodies, recognizing subtle changes in their health that might not be immediately evident to healthcare providers. They’ve seen a range of treatment strategies and have a unique perspective on what works best for them. This wealth of knowledge and experience is a form of crystallized intelligence that, combined with AI’s capabilities, could revolutionize their care.
The Intersection of AI and Dialysis Care
AI’s role in healthcare extends far beyond just data analysis. It has the potential to significantly enhance patient care, particularly for chronic conditions like kidney disease that require long-term management. For patients on dialysis, AI can help in several ways:
Personalized Treatment Plans: AI can analyze vast amounts of data — from a patient’s medical history to real-time biometric data collected during dialysis — to create personalized treatment plans. By learning from each patient’s unique experiences and responses to treatment, AI can continually refine these plans to optimize efficacy and minimize side effects.
Remote Monitoring: AI-powered wearables and mobile apps can provide continuous health monitoring, alerting patients and healthcare providers to potential problems before they become critical. This technology can also help patients understand the impact of lifestyle choices on their health, empowering them to take a more active role in their care.
Predictive Analytics: AI can use data to predict potential health risks, allowing for proactive rather than reactive care. This predictive capability can help identify complications associated with dialysis, such as infections or cardiovascular issues, well in advance.
The Role of Crystallized Intelligence in AI-Enhanced Dialysis Care
Crystallized intelligence comes into play by adding a layer of human insight to the AI’s capabilities. By combining their life-long experience and wisdom with AI’s data-driven insights, older dialysis patients can make more informed decisions about their health.
For example, patients might notice a pattern in their well-being that aligns with certain dietary choices or activity levels. This observation, based on their crystallized intelligence, can be fed into the AI system, refining the personalized treatment plan.
Similarly, patients can use their crystallized intelligence to discern between significant health changes and ‘noise.’ If an AI system alerts them to a potential issue, they can draw on their past experiences to gauge the severity of the situation and decide the best course of action.
Conclusion
AI has the potential to transform healthcare by providing personalized, proactive care. For older dialysis patients, integrating AI into their treatment can provide an opportunity to leverage their crystallized intelligence, resulting in a more nuanced, effective approach to managing their health.
Crystallized intelligence and AI are complementary in many ways. While AI provides data-driven insights and predictions, crystallized intelligence offers the wisdom and discernment that can only come from personal experience. Together, they can create a more comprehensive and effective healthcare strategy.
Moreover, AI can assist in managing the dialysis process itself, ensuring that treatments are as efficient and safe as possible. From monitoring vitals during treatment to adjusting dialysis parameters in real-time, AI can handle many technical aspects, freeing patients and healthcare providers to focus on broader health goals.
The adoption of AI in dialysis care also has the potential to improve the quality of life. With AI’s help, patients can manage their condition more independently, reducing the need for frequent hospital visits and allowing them to maintain a more normal lifestyle. This can significantly improve mental and emotional well-being, which is an important aspect of overall health for chronic disease patients.
AI also has a role in supporting dialysis patients’ emotional and psychological needs. AI chatbots, for example, can provide companionship, offer reminders for medication or appointments, and even help patients navigate the complex healthcare system. These AI tools can learn from each interaction, adapting to the patient’s needs and preferences – another example of technology and crystallized intelligence working together.
In summary, artificial intelligence offers a promising avenue to improve dialysis care and patient experience. By capitalizing on the strength of the crystallized intelligence of the aged, AI can help create a more personalized, proactive, and effective healthcare system. As AI technology evolves and our understanding of its potential deepens, we can look forward to a future where healthcare is not just about managing disease but also about supporting a rich and fulfilling life for patients of all ages.
On May 13, 2023, Neuroscience News ran an article titled “Exercise and the Brain: The Neuroscience of Fitness Explained.” We all know the brain (neuroscience) and fitness (healthy bodies) together make up the healthy brain healthy body concept. Putting all this together should be impactful to those on Dialysis. To test my hypothesis, I turned to my ChatGPT4 account, and with help from Grammarly and Pictory.AI, made the following video. The video specifically ties the three in this blog’s title inexplicably together. Enjoy!
On April 24, 2023, Eva M. Krochow, Ph.D. in Psychology Today, presented an article titled “What’s Your Locus of Control—and Why Does It Matter? Link is here: Her summary is as follows:
People with an internal locus of control feel they are in charge of their destiny.
People with an external locus of control perceive themselves as subjects to external forces.
An internal locus of control is linked to higher levels of well-being and life success.
Simple tools such as mindfulness and yoga could help to boost a sense of control.
By no stretch of the imagination, I concluded that the concept of Locus of Control should apply at least equally to those of us on Dialysis. This being so, I fired up my ChatGPT4 account with the following results. I first provided the Prompt I authored, followed by an edited version, mainly results from my Grammarly Ai. The lead graphic was generated in Bing Illustrator.
Prompt: Consider the concept of locus of control. Write an 800–1000-word blog entry about the concept as applies to patients on peritoneal dialysis.
The concept of “locus of control,” a psychological construct developed by Julian B. Rotter in the 1950s, refers to an individual’s perception of the underlying main causes of events in life. It’s about where you believe the control of your life rests – either within yourself (internal locus of control) or outside of yourself (external locus of control). This concept holds profound implications in the healthcare sector, especially in patients undergoing peritoneal dialysis (PD).
Peritoneal dialysis, a home-based treatment for kidney failure, requires patients to take an active role in their treatment. They are responsible for administering their dialysis treatments, monitoring their health, and managing potential complications. Consequently, their locus of control can significantly impact their treatment outcomes and overall quality of life.
Those with a strong internal locus of control believe that their actions and decisions significantly influence the outcomes in their life. They are more likely to feel empowered and take responsibility for managing their health. In the context of PD, these patients are typically proactive in learning about their treatment, consistent with their dialysis schedule, and vigilant in maintaining hygiene standards to prevent infections. By believing they can influence their health outcomes, they often show better treatment adherence, experience fewer complications, and report higher satisfaction levels.
On the other hand, patients with a strong external locus of control may believe that their health outcomes are primarily driven by factors beyond their control, such as luck, fate, or the competence of their healthcare team. These patients might feel less empowered, struggle with self-management tasks, and exhibit lower treatment adherence. They might be more prone to anxiety or depression, which can further hinder their ability to manage their treatment effectively.
Understanding a patient’s locus of control can aid healthcare providers in delivering personalized, effective care. For instance, patients with an external locus of control may benefit from additional support and encouragement to boost their confidence in self-care. They might need more education about the impact of their actions on their health outcomes and more regular check-ins from healthcare providers.
Meanwhile, patients with a strong internal locus of control, while generally more proactive, might risk overconfidence, neglecting to seek help when necessary. Healthcare providers must ensure these patients understand that while their self-management is crucial, seeking professional help when complications arise is equally important.
Technology also plays a pivotal role in supporting patients’ locus of control. Technological advancements in PD equipment, such as user-friendly interfaces and remote monitoring capabilities, can reinforce a sense of control and confidence in patients, reducing their dependence on healthcare providers. Simultaneously, healthcare providers can monitor patients’ health and intervene promptly, offering a safety net that can reassure all patients, regardless of their locus of control.
However, the concept of locus of control isn’t a one-size-fits-all approach. It’s crucial to respect each patient’s beliefs and feelings and consider them part of a holistic treatment approach. Some patients may prefer a more hands-on approach, while others may need more support from their healthcare team. A balance between promoting self-management and providing professional support is key to optimizing patient outcomes.
In conclusion, understanding and addressing the locus of control in peritoneal dialysis patients can have profound implications for treatment outcomes and patient satisfaction. By tailoring support based on each patient’s locus of control, healthcare providers can empower patients, promote optimal self-management, and improve overall quality of life. It’s a step towards a more personalized, patient-centered model of care that acknowledges the power of the mind in health and healing.
The Good, the Bad, and the Ugly was a 1966 spaghetti western starring Clint Eastwood that is generally accepted to be one of the best films ever produced. It made his career and others too.
Today’s popular culture embodies the film’s title as an idiomatic expression typically used when describing something thoroughly. That is, the upsides or good, downsides or bad, and that which could have or should have been done better, the ugly. In this context, I pen the following about my Dialysis Journey thus far, having started on 9/30/2022.
GOOD
BAD
UGLY
I’m here
Changing habits
Cycler alarms
Fresenius stock
Social life
Fresenius Tech Support
Met nice people
TV schedule
Sleep
Supportive team
Glucose, weight
Fainting
Takes a village
Medical meetings
No end in sight
Supplies
Lack of info on new cycler
Good:
I’m here. However you dice and slice it, dialysis is life-supporting. Without it, I would be long gone. It is working, and for that, I am thankful.
Fresenius Stock. In support of the company providing me with life-sustaining services, I chose to invest modestly in their stock at a 500-share level. On 1/20/2023, I bought these shares at $18.26 per share, for a total of $9,132.50. Today (5/10/2023), the shares are trading at $24.46 for a total gain of $3,097.50. To a degree, as the company goes, I go. I’m going OK.
Met nice people & Supportive team: Along the way of my dialysis journey, I have met a host of people, both in and out of the medical profession, that have treated me exceptionally well. I appreciate this most and hope I can live up to their expectations. In particular, I am very adorable and impressed with the sincere care and treatment provided by my Dialysis Team. They are always there, almost like Big Brother but in a supportive role which I deeply appreciate.
Takes a village. This statement is derived from an African proverb that means an entire community of people must interact with children for those children to grow in a safe and healthy environment. Recently when talking normally with a neighbor in front of our home, I went down with Orthostatic Hypotension. Seemingly in a matter of seconds, his wife was beside me, and a few seconds later, neighbors were there attending to me, and my wife was called. In all, at least eight people were attending to my needs, including calling the EMS and exporting me to our home. In my neighborhood, there are many angels watching over me, for which I am grateful. It’s a good thing in my case.
The Bad:
Changing habits. The critical need for dialysis had the greatest impact on my daily life, what I could do, when, and how. I am tied to the schedule of the dialysis requirement rather than my environment. This has impacted when I go to bed, how I sleep when there, when I get up, what and when I eat, where I go, and what I do and can do once I get there; everything. It is a massive behavioral change that no amount of classroom effort will prepare you for.
Social life. I am on Peritoneal Dialysis and have a BMW X5 SUV. I could load up the X5 with dialysis gear and travel to just about any place in the US I wanted to for up to several weeks duration without needing to stock up with dialysis disposables. This is but one aspect. I find that I cannot make rather early-in-the-day appointments without seriously curtailing or rescheduling my dialysis treatments. Same thing later in the day. If we go out with family for dinner and stay too late, I run into the fixed and firm requirement to get on the Cycler or pay the piper the next morning by having to stay on it longer. It is a very unforgiving schedule that is unbudging and intractable.
TV schedule. This may sound trite, odd, and even funny, but having to be on the Cycler by 09-9:30 PM to get up at a reasonable hour in the morning curtains TV watching in the evening. Luckily we stream everything and can start to watch a show, stop it, and continue the next evening. Still cuts into our family time in the evenings.
Glucose, weight. We, I say we because the following involves my dialysis team also, are looking for the sweet spot in the strength of my dialysate. The effort involves a balance between acceptable swelling of the feet, hands, and face (edema), and the strength (for me, a 1.5 or 2.5 dialysate) to remove fluid during dialysis. A confounding variable is that as the sugar content of the dialysate goes up and bodily fluid content increases, my glucose readings do also leading me to increase my insulin intake. So we have a critical balancing act between dialysate strength to pull out enough fluid to keep edema in check versus glucose and retention. Compound this with if fluids get to be too low, blood pressure goes down, leading to fainting because of orthostatic hypotension. These three variables interact and cannot be captured in a linear equation, differential or not. It is a little bit of this, a little bit of that, to see what works. Today at least.
Medical meetings. I attempt to keep up with my lab results and, in general, my health state in preparation for my monthly meetings with my dialysis team, but try as I might, I seem to miss the boat. What they are concerned about, or not, don’t jump out at me as problematic. What I question at the meetings from my research as being potentially problematic are, in general, glossed over. To some extent, I feel like a third wheel—an object for scientific inquiry at best.
Supplies. On at least two occasions, I have received monthly supplies from Fresenius that I am positive I did not order. I’m talking multiple boxes of dialysate. While Fresenius, for me, has done a great job giving us a heads-up on delivery, and ordering has been straightforward using the Patient Hub app, the process still is manual and cumbersome. With all the data available via the Cycler, seems automation or at least a recommended list of supplies should be generated in this information age of advancing artificial intelligence.
Lack of info on new cycler. In April 2022, over a year ago, Fresenius announced the release of a new cycler, the VersiPD, to replace the existing Liberty Cycler. Here we are, over a year later, and nada, zip, zero. Here’s what they said it would provide: “Designed from the ground-up (sic) to enhance the patient experience, VersiPD will allow patients to enjoy restful sleep through its almost silent operation, fewer disruptive alarms, and night mode. The cycler has the capability of more personalized prescription programming to meet the individual needs of a broad range of patients. VersiPD offers a large, intuitively designed touchscreen, as well as embedded videos with audio guidance to assist patients step by step through setup and treatment. The cycler battery and custom cart facilitate mobility around the home, which can further improve a patient’s quality of life.” We’re still waiting, and waiting, and waiting????
Ugly:
Cycler alarms. I have reported extensively on the excessive amount of drain alarms the Fresenius Liberty Cycler throws off. You can reliably count on alarms 3/4 of every night. Unsat!
Fresenius Tech Support. As previously reported herein, Fresenius Tech Support is an oxymoron in terminology. I have spoken with them on three occasions concerning drain alarms. Their last solution is to turn the alarms off. They are no “support” whatsoever and distract from an otherwise mutually beneficial relationship with their parent company.
Sleep. The impact of dialysis on sleep is multifactored. I have had to adjust my sleep schedule, my sleep positions, my sleep regularity, my sleep patterns, my sleep awareness to drain alarms, my concern for alarms bothering my wife, and so on. This is one of the areas most affected by dialysis.
Fainting. As previously mentioned, I have experienced low blood pressure and fainting while on both hemo and PD. It is not a fun experience and should be avoided at all costs. It is impactful in many ways. My wife has, since my single episode while on PD, taken to walking with me on my morning walk with our Golden Retriever Dickens. I bought her an electric bike for Christmas. Recently I purchased one for myself so I could accompany her on rides in the Plantation where we live. She has nixed this, hopefully for the time being, while I “prove” my stability and lack of fainting so she feels safe in my ability to ride the bike.
No end in sight. You can say there is an end if I applied for and was accepted for a kidney transplant. I’m still on the fence. I have not been able to reconcile that at my age, 84, someone else could better employ the scarce asset of transplantable kidneys.
It is important to recognize that each patient’s experience with dialysis can be unique and should be assessed on an individual basis.
That being said, there are several attributes that are commonly associated with military training that could potentially be beneficial for dialysis patients. For example:
Discipline: Military training emphasizes discipline, which can be helpful for patients who need to follow strict dietary and fluid intake guidelines while on dialysis.
Resilience: Military training often requires soldiers to push through physical and mental challenges, which can be beneficial for dialysis patients who may experience fatigue, discomfort, or other side effects of the treatment.
Attention to detail: Military training emphasizes attention to detail and following protocols, which can be helpful for patients who need to adhere to specific medication regimens or take other precautions while on dialysis.
Teamwork: Military training often requires soldiers to work together as a team, which can be beneficial for dialysis patients who may need support from family members, caregivers, or healthcare professionals.
Let’s look in more depth at the second item above, resilience. A dictionary definition is a capacity to withstand or to recover quickly from difficulties, or toughness. Further, resilience is the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands. Isn’t that what’s going on and how Dialysis impacts all of us? We need a degree of resilience to be successfully engaged in dialysis, FOREVER!
US Navy SEALs adhere to the 40% Rule initially compounded by a SEAL named David Goggins. The 40% rule is simple: When your mind is telling you that you’re done, that you’re exhausted, that you cannot possibly go any further, you’re only actually 40% done. Since Dialysis is “never done” for many of us, mentally grab ahold of the 40% Rule for yourself. Internalize it. Make it yours.
This is the last in a series of blog posts in which the US Navy’s SEAL Community’s various creeds, ethos, and codes were used as inspiration for those on Dialysis. I personally draw on their inspirational grit daily in my own dialysis life. It is my guiding light that others may also profit. See the video/ode below. Attribution: I was aided by ChatGPT4, Grammarly, and Pictory.AI in the authorship of the video.
Once upon a time, in a small coastal town in California, there lived a man with a spirit as fierce as the sea. His name was Mark “Wavebreaker” Johnson, a 100% disabled US Navy SEAL who had faced the harshest battles and emerged as a living testament to the resilience of the human spirit.
Despite the challenges that life had thrown at him, Mark lived by the SEAL credo and code, which served as a guiding light through his darkest hours. He was a man of incredible strength and determination, and even though his body had been ravaged by war, his heart and soul remained indomitable.
Mark’s days were spent in solitude at his quaint seaside cottage, where he tended to his peritoneal dialysis treatments with the same precision and discipline as he had once wielded in the field. He relied on the strict regimen to keep him alive, but it was the memories of his brothers-in-arms and the SEAL code that truly sustained him.
As the sun dipped below the horizon, Mark would often sit on his porch, gazing out at the vast ocean before him. The waves that crashed against the shore were a reminder of the power and fury of the sea, a force that had shaped him into the man he was today. He would recite the SEAL credo under his breath, allowing the words to wash over him like the tide: “I will never quit. I persevere and thrive on adversity.”
In the small coastal town, Mark was known as a humble and unassuming man, always ready to lend a hand to those in need. His neighbors respected him not only for his service to the country but also for his genuine kindness and willingness to help others without seeking anything in return.
One day, while Mark was walking along the shoreline, he encountered a young boy named Timmy who was struggling to carry a large piece of driftwood back to his home. Mark could see the determination in the boy’s eyes, and it reminded him of the fierce spirit that had carried him through his own hardships.
Without hesitation, Mark approached Timmy and offered his assistance. Together, they carried the driftwood to the boy’s home, and Mark shared stories of his time as a Navy SEAL, emphasizing the importance of the SEAL credo and code. Timmy listened intently, his eyes filled with admiration and curiosity.
As the weeks turned into months, Mark and Timmy grew closer. They spent their days exploring the beach, collecting shells, and discussing life. Mark taught Timmy the values of honor, loyalty, and perseverance, and in turn, Timmy reminded Mark that even in the face of adversity, one could find joy and purpose.
Through their friendship, Mark found a renewed sense of purpose and meaning in his life. Although his body remained weakened, his spirit remained unbroken. Mark knew that his days on this earth were limited, but he continued to live each day with the unwavering determination and courage that had defined him as a Navy SEAL.
The years passed, and Mark’s health continued to decline. Yet, even as his body betrayed him, his spirit remained strong, and his friendship with Timmy grew. Eventually, Mark passed away, leaving a legacy of courage, strength, and unwavering determination.
Timmy, forever changed by Mark’s wisdom and friendship, honored his memory by joining the Navy and eventually becoming a SEAL. As he embarked on his journey, he carried the lessons he had learned from Mark with him, determined to uphold the SEAL credo and code as a tribute to the man who had taught him so much.
Ultimately, Mark “Wavebreaker” Johnson’s story is one of courage, resilience, and the power of friendship. His life had been shaped by the unforgiving forces of the ocean and the battles he had fought, but it was his humble nature and unwavering spirit that defined him. The SEAL credo and code served as his compass through the stormy seas of life, guiding him toward the light of hope even when the waves threatened to engulf him.
As the years went by, Timmy grew into a strong and courageous Navy SEAL. He carried the memory of Mark with him on every mission, drawing strength from the wisdom and lessons his friend had imparted to him. Through Timmy, Mark’s legacy lived on, and his spirit continued to inspire a new generation of warriors who embodied the values of the SEAL credo and code.
The small coastal town never forgot Mark “Wavebreaker” Johnson, the humble hero who had once walked their shores. In his honor, a monument was erected by the beach, depicting Mark’s determined gaze, forever looking out at the ocean that had shaped him.
In the hearts of those who knew him and in the actions of those he inspired, Mark’s memory lives on, a testament to the indomitable spirit of a true Navy SEAL. His story serves as a reminder that even when life’s storms batter the shores of one’s soul, it is possible to rise above, persevere, and find meaning in the face of adversity.
And so, the legacy of Mark “Wavebreaker” Johnson continues, etched into the sands of time like the waves that had shaped him, a humble hero whose spirit and determination would never be forgotten.
The TAKEAWAY from this story for us on Dialysis is NEVER RING THE BELL!!
Attribution: This story was written with encouragement from ChatGPT4, guidance by Grammarly, and insights from me. The lead picture is of a US Navy SEAL surfing on a submarine. He got into lots of trouble for this “feat.”
The embedded video above, made with the assistance of ChatGPT4 and Pictory.AI, captures the essence of the USNavy SEAL’s code of “leaving no man behind” as applies to those of us on Dialysis.
